Information Collection

Medicare - Regulation Berc-273f (secs. 40b.334(b) & (c)(d)) Procedures For Determining Whether Providers, Practitioners, Or Other Suppliers Of Services Are Liable For Certain

IC 113794 under ICR 198808-0938-006 · OMB 0938-0465.

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IC Title:	MEDICARE - REGULATION BERC-273F (SECS. 40B.334(B) & (C)(D)) PROCEDURES FOR DETERMINING WHETHER PROVIDERS, PRACTITIONERS, OR OTHER SUPPLIERS OF SERVICES ARE LIABLE FOR CERTAIN	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-77				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,405	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	2,324,150	2,324,150
Annual IC Time Burden (Hours)	193,679	193,679
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.